Medicaid
Medicaid is a government program designed to help low income people pay for medical care. It is jointly funded by the states and the federal government.
Congress has passed a bill (“One Big Beautiful Bill”–OBBB) that will reduce federal Medicaid funding by 15 percent over the next decade.* This will raise premiums to the extent that 11.8 million Americans will lose healthcare coverage, and this figure will rise to 17 million by 2034. Analysts from Yale and the University of Pennsylvania estimate that about 50,000 preventable deaths will occur annually. Rural areas, with a disproportionate rate of poverty will be hit hardest, and safety net hospitals (those serving predominantly low income populations) will inevitably have to close.
If states are unable to backfill the federal cuts, the numbers will be higher.
Hepatitis B Vaccine
Hepatitis is an inflammation of the liver with many causes, with the Hepatitis B virus one of the prominent culprits. Infection with this virus, often a subclinical one (i.e., one that is inapparent clinically) can result in chronic liver disease, cirrhosis (irreversible scarring of the liver), liver failure, liver cancer, and death.
A vaccine against the Hepatitis B virus was developed in the early 1980s. In 1991, administration of the vaccine became part of the routine vaccination regimen for children. In 1985, 26,654 cases of acute Hep B virus infection in children per year were reported. Today, the number of children infected with the virus in the US is less than 400 per year, almost all of them in children not vaccinated against the disease. Mortality from the virus has been halved.
The newly constituted Advisory Committee on Immunization Practices (ACIP, which advises the CDC on vaccination policy) recently delayed a decision on changing recommendations for administration of the Hepatitis B vaccine, citing the need for more data.
Here are some data: If given at birth, the vaccine reduces the risk of Hepatitis B by 98%, cancer by 84 percent and death from liver disease by 70 percent. The longer the interval from birth to the first administration of the vaccine, even if it is a matter of months, the worse the long term outcomes.
President Trump recently recommended, with his Health and Human Services secretary looking on, that the vaccination against Hepatitis B be delayed until the age of 12.
Tylenol and Autism
Twenty percent of pregnant women experience fever during pregnancy. Especially if the fever is 102 degrees or greater, the risks for the fetus are important. These include premature births, developmental anomalies such as heart disease, and neurodevelopmental problems such as spina bifida.
Fevers from any cause should be brought down quickly. Tylenol is the medication of choice and reduces the odds of bad pregnancy outcomes dramatically.
Does Tylenol cause autism? Some research has found an association between pregnant women taking Tylenol and the eventual risk of autism in the fetus. Critics of these studies point out that they failed to take into account confounding variables (inapparent factors that make conclusions unreliable) such as genetics.**
On the other hand, repeated studies, which include millions of observations of pregnancies, conclude that Tylenol is safe in pregnancy. Sweden maintains a health registry which is second to none. Using this source, American researchers examined the medical records of 2.5 million Swedish children, followed them for an average of 20 years, and concluded that the use of Tylenol by pregnant women is safe. A study from Japan followed 200,000 children and reached the same conclusion.
Authoritative bodies that accept the conclusions of this research, include The American Academy of Pediatrics, The Society for Maternal-Fetal Medicine, and The American College of Obstetrics and Gynecology.
Nevertheless, our president, with the health secretary at his side, has exhorted pregnant women not to take Tylenol during pregnancy under any circumstances. Pregnant women who follow this advice risk a plethora of fetal abnormalities if they refrain from taking Tylenol when they have a fever or severe pain. Another adverse effect in women who take the president’s position seriously is the guilt and anxiety that may attend Tylenol using women who have autistic children.
Even physicians who think Tylenol is safe in pregnancy caution against injudicious use of the drug by pregnant women. As with all interventions in medicine, a cost/benefit analysis is paramount. The data overwhelmingly favor responsible use of Tylenol in pregnancy for fevers and severe pain.
The non-nuanced advice of two non–physicians is inappropriate–and wrong.
*The OBBB will raise the national debt by three trillion dollars over the next decade.
**Genetic factors play a significant role in the development of autism.